Methotrexate versus conventional disease-modifying antirheumatic drugs in the treatment of non-anterior sarcoidosis-associated uveitis

• Published in: British journal of ophthalmology Vol. 109; no. 1; pp. 34 - 40
• Main Authors: Leclercq, Mathilde, Sève, Pascal, Biard, Lucie, Vautier, Mathieu, Maalouf, Georgina, Leroux, Gaëlle, Domont, Fanny, Toutée, Adélaïde, Fardeau, Christine, Sales de Gauzy, Thomas, Touhami, Sara, Kodjikian, Laurent, Cacoub, Patrice, Bodaghi, Bahram, Saadoun, David, Desbois, Anne-Claire
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.01.2025; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Aged; Antirheumatic Agents; Antirheumatic Agents - therapeutic use; Azathioprine; Azathioprine - therapeutic use; Biopsy; Drug dosages; Drugs; Edema; Female; Follow-Up Studies; Granulomas; Humans; Immunology; Immunosuppressive Agents; Immunosuppressive Agents - therapeutic use; Inflammation; Life Sciences; Macula; Male; Medical imaging; Methotrexate; Methotrexate - therapeutic use; Middle Aged; Mycophenolic Acid; Mycophenolic Acid - therapeutic use; Patients; Retrospective Studies; Santé publique et épidémiologie; Sarcoidosis; Sarcoidosis - complications; Sarcoidosis - drug therapy; Steroids; Treatment Medical; Treatment Outcome; Uveitis; Uveitis - drug therapy; Visual Acuity; Visual Acuity - physiology; Drugs; Macula; Treatment Medical; Inflammation; Immunology
• ISSN: 0007-1161; 1468-2079; 1468-2079
• DOI: 10.1136/bjo-2024-325163

AimsTo compare the safety and efficacy of methotrexate (MTX), mycophenolate mofetil (MMF) and azathioprine (AZA) in non-anterior sarcoidosis-associated uveitis.MethodsRetrospective study including non-anterior sarcoidosis-associated uveitis according to the revised International Workshop on Ocular Sarcoidosis criteria. The primary outcome was defined as the median time to relapse or occurrence of serious adverse events leading to treatment discontinuation.Results58 patients with non-anterior sarcoidosis-associated uveitis (MTX (n=33), MMF (n=16) and AZA (n=9)) were included. The time to treatment failure (ie, primary outcome) after adjustment for corticosteroids dose and the presence of vasculitis was significantly higher with MTX (median time of 34.5 months with MTX (IQR: 11.8 –not reached) vs 8.4 months (3.1–22.9) with MMF and 16.8 months (8.0–90.1) with AZA (p=0.020)). The risk of relapse at 12 months was more than twice lower in MTX as compared with MMF (p=0.046). Low visual acuity at the last visit was significantly lower with MTX (4% vs 9% in MMF vs 57% in AZA group (p=0.008)). Regarding all 75 lines of treatment (MTX (n=39), MMF (n=24) and AZA (n=12)), MTX was more effective than MMF and AZA to obtain treatment response at 3 months (OR 10.85; 95% CI 1.13 to 104.6; p=0.039). Significant corticosteroid-sparing effect at 12 months (p=0.035) was only observed under MTX. Serious adverse events were observed in 6/39 (15%), 5/24 (21%) and 2/12 (17%) with MTX, MMF and AZA, respectively.ConclusionIn non-anterior sarcoidosis-associated uveitis, MTX seems to be more efficient compared with AZA and MMF and with an acceptable safety profile.